Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals Revision > Neuro > Flashcards

Neuro Flashcards

1
Q

L3 root compression? (4)

A

Sensory loss over anterior thigh
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

L4 root compression? (4)

A

Sensory loss over anterior knee
Weak quadriceps
Reduced knee reflex
Positive femoral stretch test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

L5 root compression? (4)

A

Sensory loss over dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

S1 root compression?

A

Sensory loss over posterolateral aspect of leg and lateral foot
Weakness of plantarflexion
Reduced ankle reflex
Positive sciatic nerve stretch test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When to consider MRI for root compression?

A

If symptoms persist for 4-6 weeks despite analgesia, physiotherapy and exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Initial signs of SACD development in B12 deficiency (e.g. 2 years after gastrectomy for cancer)? (3)

A

Loss of ankle reflexes
(knee reflexes may be brisk)
Loss of vibration and pin prick
Wide-based ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Difference between migraine symptoms in kids and adults? (3)

A

In kids shorter lasting, more commonly bilateral, and GI disturbance more prominent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Can aura for migraine occur without headache?

3 things which make the sensory/motor disturbance an aura?

A

Yes

  1. Fully reversible
  2. Develop over at least 5 mins
  3. Last 5-60 mins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

5 common migraine auras?

A
  • Double vision
  • Visual symptoms affecting one eye (scintillating scotoma)
  • Motor weakness
  • Poor balance
  • Decreased level of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Becker/Duchenne MD:

  • inheritance? problem with what gene?
  • Symptoms they have in common? (3)
  • Differences between them? (2)
  • Difference between these and myotonic dystrophy?
A

Autosomal Dominant
Dystrophin gene - large membrane protein which attaches membrane to actin in muscle

  • Progressive proximal muscle weakness
  • Calf pseudohypertrophy
  • Gower’s sign: child uses arms to stand from squatted position
  • Duchenne onset from 5 y/o, Becker’s is later in teens
  • 30% in Duchenne have intellectual impairment, this is very rare for Becker

Myotonic dystrophy - muscles have increased tone, unable to relax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What muscles are generally spared in MND?

A

Extraocular - eye movements spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Loss of thumb abduction after colles #?

A

Median nerve injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does ulnar nerve damage present in hand?

A

Weakness of 4th and 5th fingers, with loss of sensation of these fingers also front and back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MRI with/without contrast should be used for demyelinating lesions e.g. MS?
What is seen on MRI with MS?
On CSF?

A

WITH contrast

MRI:

  • High signal T2 lesions
  • Periventricular plaques
  • Dawson fingers: hyperintense lesions perpendicular to corpus callosum extending up like little fingers

CSF:

  • Oligoclonal bands
  • Increased intrathecal synthesis of IgG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5 month old with seizures and developmental delay - EEG shows hypsarrhythmia?
What is the typical seizure of this condition like?
Prognosis?

A

Infantile spasms (West Syndrome)

Salaam attacks - flexion of head, trunk and limbs with extension of arms
(lasts 1-2 secs and repeated up to 50 times)

Poor prognosis - progressive mental handicap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What diet is good for treatment-resistant epilepsy in kids?

A

Ketogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

1st step in first aid of patient with raised ICP?

A

Head elevation to 30 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of raised ICP? (5)

Symptoms? (5)

A
  • Idiopathic intracranial hypertension
  • Traumatic head injuries
  • Infection (e.g. meningitis)
  • Tumours
  • Hydrocephalus
Headache
Vomiting
Reduced consciousness
Papilloedema
Cushing's triad - widening pulse pressure, bradycardia, irregular breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigations for raised ICP? (3)

A
  • CT/MRI key to see underlying cause
  • Increased opening pressure on LP
  • Invasive - catheterisation of lateral ventricle to measure pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of raised ICP?

A

(Ix and treat underlying cause)

  • Head elevation to 30 degrees
  • IV mannitol
  • Controlled hyperventilation (reduce pCO2, cerebral vasoconstriction, temporary lowering of ICP)
  • Removal of CSF (e.g. repeated LP in idiopathic ICH, or ventriculoperitoneal shunt)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q 
Is Guillain Barre painful?
Cranial nerve involvement?
Autonomic involvement?
Why can papilloedema occur?
Ix? (2)
A

65% experience back/leg pain

Cranial: diplopia, bilateral facial nerve palsy, oropharyngeal weakness common

Autonomic: urinary retention, diarrhoea

Papilloedema: decreased CSF resorption

Ix:

  • LP: raised protein but normal WBC
  • nerve conduction studies: decreased motor nerve velocity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Apart from weakness, what other symptoms can people get with Bells’ palsy?
Management? (2)
When should they show signs of improvement?
Prognosis?

A
  1. Post-auricular pain (often precedes paralysis)
  2. Altered taste
  3. Dry eyes
  4. Hyperacusis
  • Prednisolone PO within 72 hours of onset
  • artificial tears and eye lubricants

<3 weeks - if not improvement refer urgently to ENT

Most recover fully in 3-4 months, if untreated 15% have permanent mod-sev weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Should prokinetics e.g. metoclopramide be used in kids with GI disturbance in migraines?

A

No - they should be used with extreme caution in kids due to common SE of asthenia, parkinsonism and depression

(reserved for chemo etc)

(also they are generally CI in epilepsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Tuberous sclerosis:

  • inheritance?
  • 2 neurological features?
  • 5 derm features?
  • 1 in eye?
  • 1 in kidney?
A

Autosomal Dominant

Neuro:

  • Epilepsy
  • Intellectual impairment

Skin:

  • Depigmented ash-leaf macules (fluoresce under UV)
  • Roughened patches of skin over lumbar spine (Shagreen patches)
  • Angiofibromas in butterfly distribution over nose (adenoma sebacum)
  • Subungal fibromas
  • Cafe-au-lait macules

Eye:
- Retinal hamartoma

Kidney:
- PKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the 4 Parkinsons Plus syndromes?

A
  • Multiple System Atrophy
  • Lewy Body Dementia
  • Progressive Supranuclear Palsy
  • Corticobasal degeneration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Apart from parkinsonism, what 3 other things are seen in progressive supranuclear palsy?
Response to drugs?

A
  • Impairment of vertical gaze: down worse than up (complain of trouble reading/descending stairs)
  • Postural instability and falls (stiff, broad-based gait)
  • Cognitive impairment (frontal lobe dysfunction)

Poor response to L-dopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Motor weaknesses in common perineal nerve injury? (3)
Sensory loss (2)
What muscle compartments will have wasting? (2)

A

Weakness of:

  • foot dorsiflexion
  • foot eversion
  • extensor hallucis longus

Sensory loss:

  • dorsum of foot (incl 1st web space)
  • lower lateral part of leg

Wasting of:
- anterior and lateral leg compartment muscles
(anterior = deep; lateral = superficial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What blood component is it important to check in workup of TIA? Why?

A

Glucose

Hypoglycaemia can cause focal neurological symptoms and mimic TIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is a TIA defined?

A

New definition is tissue based:
A transient episode of neurological dysfunction caused by focal brain, cord or retinal ischaemia, without acute infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Immediate management of a TIA?
Referral if suspected TIA in last 7 days?
If suspected TIA >7 days ago?
What is a crescendo TIA and what is the referral for this?
Referral if suspected cardiac/carotid source of stroke?
Driving after suspected TIA?

A

RULE OUT BLEED!!!
Give aspirin 300mg immediately
(unless bleeding disorder, already taking low-dose aspirin or it is CI)

  • Be seen in <24 hours by stroke specialist
  • Be seen asap in <7 days by a stroke specialist

Crescendo TIA = >1 TIA - admit for observation urgently

  • also admit for observation urgently

Don’t drive until after being seen by specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Antithrombotic therapy post-TIA?

When is carotid endarterectomy performed?

A

Clopidogrel 1st line

Aspirin + dipyramidole 2nd line (if cannot tolerate clopiogrel e.g. diarrhoea)

  • If stenosis >70% and stroke/TIA in carotid territory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How to tell if a 3rd nerve palsy is a surgical problem?
3rd nerve palsy due to posterior communicating artery aneurysm?
Other causes of 3rd nerve palsy? (5)

A

Pupil is dilated

Painful - pain around/behind the eye and/or generalised headache, 3rd nerve palsy and dilated pupil

  • diabetes
  • vasculitis (GCA, SLE) or others (MS, amyloid)
  • uncal herniation through tentorium if raised ICP
  • cavernous sinus thrombosis
  • Weber’s syndrome: ipsilateral 3rd nerve palsy with contralateral hemiplegia - midbrain stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Post-LP headache:

  • when does it come on?
  • how long does it last?
  • what position is it worse in?
  • if it doesn’t resolve in set time period?
A

24-48 hours (occurs due to low pressure)

  • <72 hours
  • worse when upright (better lying down)
  • If >72 hours then treatment indicated to prevent subdural haematoma:
    blood patch, epidural saline or IV caffeine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Scoring system for suspected stroke?

A

After FAST

ROSIER:
First exclude hypoglycaemia, then stroke is likely if any of the following:
- LOC/syncope
- Seizure activity
- Asymmetrical facial, arm or leg weakness
- Speech disturbance
- Visual field defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Ix for suspected stroke?

A

Non-contrast CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Who can initiate treatment for Parkinson’s?

1st line?

A

Specialists only

1st line:

  • if motor symptoms affect QOL: levodopa
  • if not affecting QOL: dopamine agonist, MAO-B inhibitor or levodopa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Unwanted effects of levodopa? (5)
Why can it not be stopped immediately?
What type of Parkinsonism is it not used in?

A 
Dyskinesia (involuntary writhing)
'On-off' effect
Dry mouth
Postural hypotension
Psychosis

DO NOT stop levodopa immediately - risk of acute dystonia

NOT used in drug-induced parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What dopamine agonists are mainly used in Parkinsons?

Why try to avoid ergot-derived ones such as cabergoline or bromocriptine?

A

Ropinorole or Apomorphine

Cabergoline/Bromocriptine can cause retroperitoneal, cardiac and pulmonary fibrosis. Before commencing baseline echo, creatinine and CXR should be taken and monitor patients closely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Example of a MAO-B inhibitor?

How does it work?

A

Selegiline

Inhibits breakdown of dopamine. Higher doses also prevent breakdown of serotonin and NA (antidepressant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

2 examples of COM-T inhibitors?

How is it used?

A

Tolcapone, entecapone

In conjunction with levodopa as it prevents breakdown of dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What type of drugs are used for drug-induced parkinson’s?

A

Antimuscarinics - procyclidine, trihexyphenidyl etc

Help tremor and rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

For each of these where is the lesion and describe the aphasia:

  • Wernicke’s?
  • Broca’s?
  • Conduction?
  • Global?
A

Wernicke’s (Receptive):

  • Lesion in superior temporal gyrus (MCA)
  • Comprehension impaired, speech is fluent but makes no sense - ‘word salad’

Broca’s (Expressive):

  • Inferior frontal gyrus (MCA)
  • Comprehension normal, speech is non-fluent and halting

Conduction:

  • Lesion in arcuate fasciculus (between broca and wernicke)
  • speech fluent but repetition is poor - aware of errors they are making

Global:

  • Lesion affecting all 3
  • Severe receptive and expressive aphasia - can communicate using gestures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

MS management:

  • acute relapse?
  • for fatigue?
  • for spasticity?
  • bladder dysfunction?
  • oscillopsia (visual field oscillation)?
A

Relapse: IV methylpred 5 days - shortens relapse but no effect on recovery

Fatigue:

  1. Rule out anaemia, thyroid, depression
  2. Amantadine
  3. Mindfulness, CBT

Spasticity:

  1. Baclofen
  2. Gabapentin
  3. Diazepam, Dantrolene or Tinzadine

Bladder - urgency, frequency, overflow, incontinence etc:
1. bladder USS to assess residual volume
2. If normal residual volume, anticholinergics may help frequency
3. If significant residual volume - intermittent self-catheterisation
(be aware anticholinergics may worsen symptoms)

Oscillopsia:
- Gabapentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

DMARDs for MS?

A

B interferon

Glatiramer acetate - immunomodulator

Natulizumab - recombinant MAb, against leucocytes, prevents crossing of BBB

Fingolimod - prevents lymphocytes leaving lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Hoarseness and uvula deviating to right?

A

Left vagus nerve lesion

uvulAWAY from side of lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What tracts are affected in SACD?

A

DCML - proprioception, vibration

Lateral corticospinal - spasticity, brisk knee reflexes, positive babinski
ankle jerks typically lost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Chronic form of Guillain barre?

A

Chronic inflammatory demyelinating polyneuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Causes of CNIII palsy?

What is seen?

A

Causes:

  • diabetes
  • Uncle herniation through tentorium cerebelli in raised ICP
  • Posterior communicating artery aneurysm (painful)
  • vascular (vasculitis, cavernous sinus thrombus, Weber Syndrome - midbrain stroke)

Signs:

  • down and out eyeball
  • dilated
  • ptosis
  • pupil won’t constrict to light, but light shone in that eye causes consensual constriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q 
Cerebral venous sinus thrombosis:
- presentation of sagittal?
- cavernous?
- lateral?
Gold standard Ix?
A

All have insidious onset over hours-days of severe headache, N&V

Sagittal:

  • may cause seizures and hemiplegia
  • parasagittal wartershed infarcts may be seen

Cavernous:

  • periorbital oedema
  • ophthalmoplegia - 6th nerve before 3rd and 4th
  • central retinal vein thrombosis
  • 5th nerve involvement may cause hyperaesthesia of upper face/eye pain

Lateral:
- 6th and 7th nerve palsies

Ix: MRI venogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Degenerative cervical myelopathy Ix?

Rx?

A

MRI

Decompression surgery - best outcome within 6 months
Physio should only be initiated by specialists as manipulation can worsen spinal cord damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Cushing’s triad?

A

Bradycardia
Irregular breathing
Hypertension with a WIDE pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Left sided facial weakness - what side and U/L motor neurone would be affected and how can you discriminate?

A

Left facial weakness

Right Upper motor neurone
If the forehead muscles are spared

Left Lower motor neurone
If the forehead muscles are affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Causes of bilateral facial muscle weakness?

A 
GBS
Sarcoidosis (parotid swelling)
Lyme disease
Bilateral acoustic neuromas (NF2)
Bell's palsy - 1% Bells Palsy are bilateral but Bells Palsy causes 25% bilateral facial weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Causes of LMN facial palsy?

A 
Bell's palsy
Ramsay Hunt Syndrome 
Acoustic neuroma
Parotid tumour
HIV
Diabetes
MS (may also cause UMN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Can Bell’s Palsy be painful?

A

Yes in 50% there may be some pain

If no vesicles in ear though then not Ramsay Hunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How to test if fluid from er/nose is CSF?

A

Bedside - glucose - esp in trauma

Gold standard - beta-2 transferrin (but this takes about a week to get back)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

MND - features of:

  • ALS?
  • Primary Lateral Sclerosis?
  • Progressive Muscular Atrophy?
  • Progressive Bulbar/Pseudobulbar Palsy
A

ALS:

  • UMN and LMN signs
  • familial - chromosome 21
  • 25% have bulbar onset

PLS:
- UMN signs only

Progressive muscular atrophy:

  • LMN signs only
  • Distal before proximal
  • best prognosis

Progressive Bulbar Palsy:

  • Palsy of muscles of chewing, swallowing and face - brainstem motor nuclei
  • worst prognosis

(bulbar = LMN, pseudo bulbar = UMN of corticobulbar tracts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Difference between spasticity and rigidity?

A

Spasticity:

  • caused by motor tract UMN e.g. cortex, brainstem, corticospinal tract
  • On quick movement there is initial resistance which melts away, no resistance on slow movement (‘clasp knife’)

Rigidity:

  • caused by extrapyramidal e.g. basal ganglia
  • resistance on slow movement, and doesn’t melt away on quick movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

MOA of ondansetron?

Where does it act?

A

5-HT3 antagonist

CTZ in the medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

1st line management of absence seizures?

A

Sodium valproate or ethosuxomide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

If patient is brought into A&E in a status, most important 2 causes to rule out first?

A

Hypoxia

Hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Precipitants of migraines?

A

CHOCOLATE

Chocolate
Hangovers
Orgasms
Cheese/caffeine
Oral contraceptives
Lie-ins
Alcohol
Travel
Exercise
63
Q

Which type of Parkinson’s treatment is most linked with impulse control issues?

A

Dopamine agonists

Bromocriptine, Ropinirole, Pramipexole, Cabergoline

Gambling, sexual, food etc

64
Q

4 features of acoustic neuroma?

A

Tinnitus
Vertigo
Hearing loss
Absent corneal reflex

65
Q

ACA stroke?
MCA stroke?
PCA stroke?
Basilar stroke?

A

ACA:

  • contralateral hemiparesis/sensory
  • lower extremity worse

MCA:

  • contralateral hemiparesis/sensory
  • upper worse then lower
  • contralateral homonymous hemianopia
  • Aphasia

PCA:

  • contralateral homonymous hemianopia with macular sparing
  • visual agnosia

Basilar:
- locked in syndrome

66
Q

Anterior inferior cerebellar stroke?

A

Lateral Pontine Syndrome

  • ipsilateral facial pain/temperature
  • Contralateral pain/temperature loss
  • ipsilateral ataxia, nystagmus

so far same as PICA, but with addition of…

  • ipsilateral facial paralysis and deafness
67
Q

Posterior inferior cerebellar stroke?

A

Lateral medullary syndrome
Wallenberg syndrome

  • ipsilateral facial pain and temperature loss
  • contralateral limb pain and temperature loss
  • ipsilateral nystagmus
68
Q

Weber’s Syndrome?

A

Stroke of PCA branches that supply midbrain

  • ipsilateral CNIII palsy
  • contralateral weakness of both limbs
69
Q

1st line and 2nd line options for generalised tonic clonic seizures?

A

1st - valproate

2nd line - lamotrigine, carbamazepine

70
Q

1st line options for absence seizures?

What might make them worse?

A

1st - valproate or ethosuximide
(Valproate esp good if co-existent tonic-clonic)

DO NOT give carbamazepine - might make it worse

71
Q

1st line and 2nd line options for myoclonic seizures?

A

1st - valproate

2nd - lamotrigine, clonazepam

72
Q

1st line and 2nd line options for focal seizures?

A

1st line - carbamazepine or lamotrigine

2nd line - levetiracetam, oxcarbazepine, valproate

73
Q

When can antiepileptic drugs be stopped and over how long should they be withdrawn?

A

Seizure free for >2 years and stopped over 2-3 months

74
Q

Anticoagulation therapy post-stroke if AF is the cause?

A

Warfarin or DOAC

Xa inhibitor e.g. apixaban, or direct Thrombin inhibitor e.g. dabigatran

75
Q

Stroke:

  • Apart from thrombolysis, what should be started in the first couple of days?
  • What is the exception to this?
  • Long-term treatment after acute stroke?
  • BP target after stroke?
A

Aspirin within 24 hours
Statin within 48 hours
(or alternative anti platelet if aspirin not tolerated)

If on anticoagulant (e.g. for prosthetic valve) stop it for 7 days and start aspirin after this

If from AF - start warfarin/DOAC
If not - start clopidogrel
After 2 weeks

Aim for BP<130/80, try to avoid B blockers

76
Q

Common peroneal nerve lesion features?

A
  • weakness dorsiflexion (deep)
  • weakness eversion (superficial)
  • weakness extensor hallucis longus
  • wasting of anterior tibial and peroneal (lateral) muscles
  • sensory loss dorsum of foot and lateral lower leg
77
Q

What is seen on LP with GBS?

What antibodies can be tested for?

A

increased protein
normal WCC

anti-ganglioside

78
Q

Side effects phenytoin? (6)

A 
Gingival hyperplasia
Hirsutism
Megaloblastic anaemia
Peripheral neuropathy
Lymphadenopathy
Osteomalacia (enhanced VitD metabolism)
79
Q

in TIA, what are the only 3 occasions aspirin should not be given immediately?

A
  1. Patient has bleeding disorder or is taking anticoagulant - admit immediately for imaging to rule out stroke
  2. Patient is already taking low-dose aspirin - just continue this until seen by specialist
  3. Aspirin is contraindicated
80
Q

Red flags which prompt immediate referral in trigeminal neuralgia?

A
  • sensorineural hearing loss
  • symptoms or FHx of MS
  • optic neuritis
  • only affecting ophthalmic division
  • bilateral
  • sensory change
  • <40 y/o
81
Q

What is important to tell pts taking levodopa?

What is used as rescue medication for acute ‘off’ states?

A

Must be taken at same time each day

Apomorphine

82
Q

Anti-emetic to be used for Parkinson’s?

A

Domperidone

83
Q

Features of corticobasal degeneration?

A

Parkinson’s plus sydrome

Rigidity and muscle weakness in one limb with apraxia (loss of purposeful movement)
Phantom limb phenomenon

84
Q

Difference between postural tremor and intention tremor?

Causes of each

A

Postural - worse when holding arms out, persists during movement but doesn’t get worse during the movement

Causes: anxiety, alcohol withdrawal, hyperthyroid, salbutamol, caffeine, lithium, valproate, TCA, essential

Essential - AD

Intention - task oriented, made worse throughout range of movement

Causes: cerebellar disease (MS, stroke), Wilson’s disease

85
Q

Causes of dystonia (not acute like antipsychotics):

  • cervical?
  • eyes?
  • jaw?
  • vocal cords?
  • limbs?
A

Cervical - muscle strain, OA

Eyes - myasthenia, dry eyes

Jaw - myasthenia, TMJ dysfunction

Vocal cords - laryngitis, polyps
(coarse, strained voice)

Limbs - overuse, nerve entrapment

86
Q

Management of dystonia?

A

Anti-spasmodic: Baclofen

Focal: botulinum injection

Acute: Procyclidine

87
Q

What is a chorea?

A

Non-rhythmical, irregular, purposeless movement that flits and flows from one body part to another

(e.g. facial grimacing, writhing of shoulders, rapid movements of fingers)

88
Q

Huntington’s:

  • Inheritance?
  • age of onset?
  • Presentation?
  • management?
A

AD - CAG repeat in Chr4 producing a neurotoxin resulting in degeneration of striatum

Usually 4th decade - presents earlier with each generation (genetic anticipation)

Triad of emotional, cognitive and motor neurone disturbance
Early: clumsy, chorea, irritability, depression, agitation
Late: chorea, myoclonus, rigidity, fits, dementia, loss of ability to speak/swallow

Management: supportive - lifespan 15 years

89
Q

Sydenhams chorea?

A

Self limiting chorea seen in children after strep throat infection

90
Q

What is myoclonus

A

Sudden, involuntary muscle jerks - can be normal, abnormal if >5 of these movements

91
Q

Drugs that can cause parkinsonism?

A

Metoclopramide
Antipsychotics]
Amiodarone

92
Q

Causes of myoclonus?

A 
Genetic - benign essential (same as tremor)
Stroke, SOL, head injury
CJD
Levodopa
Alcohol withdrawal
Liver/renal failure
Hyponatraemia
93
Q

What are tics?
Primary tic disorder?
Secondary?

A

involuntary stereotyped movements or vocalisations, which are unable to be suppressed. Attempts to suppress cause anxiety and discomfort, which is relieved upon completing the tic

Primary: Tourettes - start in childhood

Secondary: autism, huntington’s, wilson’s, haemochromatosis - present in childhood or adulthood

94
Q

MND is linked to which type of dementia?

A

Frontotemporal

95
Q

Antibodies for myasthenia gravis?

A

anti-AChR

anti-MuSK

96
Q

Antibodies for LEMS?

Management?

A

Anti-P/Q VGCC antibodies

3,4 - diaminopyradine
IVIG

97
Q

Occipital lobe seizures?

A

Flashes
Spots
Lines
General visual disturbances

98
Q

SE valproate?

A 
Reversible hair loss
Ataxia
Tremor
Pancreatitis
Liver failure
Weight gain
Teratogen - NTD
Thrombocytopaenia
Oedema
99
Q

SE lamotrigine? (4)

A

Maculopapular rash
SJS
DIC
Photosensitivity

100
Q

SE levetiracetam?

A

mood swings

101
Q

SE carbamazepine?

A

Impaired balance
Leucopaenia
Double/blurred vision
Impaired balance

102
Q

What increases risk of SUDEP?

A

poorly controlled
Smoking
Use of illicit drugs

103
Q

DVLA and epilepsy:

  • first unprovoked seizure?
  • epilepsy and seizure?
  • withdrawing medications?
A

First unprovoked seizure:

  • if no structural problem and no epileptic activity on EEG then 6 months
  • if not then 12 months

With epilepsy:

  • can’t drive for a year
  • no HGV for 5 years

Withdrawing medication:

  • cannot drive whilst meds are being withdrawn
  • cannot drive for 6 months after last dose
104
Q

What 2 anti epileptics are P450 inducers?

What one is an inhibitor?

A

Inducer: carbamazepine and phenytoin

Inhibitor: valproate

105
Q

Can valproate and carbamazepine be given to breastfeeding mothers?

A

Yes

106
Q

10 features featuring pseudo seizures?

A 
pelvic thrusting
family member with epilepsy
female
crying after attack
don't occur when alone
gradual onset
no tongue/tip of tongue biting
no incontinence
eyes open
rhythmic/pattern
107
Q

Lhermitte and Uhtoffs signs?

A

in MS:

Lhermitte - electric shock down spine and arms when head bent forward

Uhtoffs - worse in head and exercise

108
Q

Timescale for episodes in MS to be diagnostic?

A

Must last at least 1 hour and be at least 30 days apart

109
Q

If someone has optic neuritis, how many plaques on MRI suggest MS?

A

> 3 plaques in white matter give 50% chance of MS in 5 years

110
Q

LP with MS?

A

IgG oligoclonal bands (that aren’t in serum)

111
Q

Nerve roots:

  • musculocutaneous?
  • axillary?
  • radial?
  • median?
  • ulnar?
A

Musculocutaneous: C5-7

Axillary: C5/6

Radial: C5-T1

Median: C6-T1

Ulnar: C8-T1

112
Q

Nerve roots:

  • lateral cutaneous nerve of thigh?
  • femoral?
  • obturator?
  • sciatic?
  • Tibial?
  • common fibular?
  • superficial fibular?
  • deep fibular?
A

Lat cut: L2/3

Femoral: L2-4

Obturator: L2-4

Sciatic: L4-S3

Tibial: L4-S3

Common fib: L4-S2

Sup fib: L4-S1

Deep fib: L4-S1

113
Q

Causes of mono neuritis multiplex?

A
  • diabetes
  • rheumatoid
  • carcinomatosis
  • Vascilitis: wegeners, PAN
  • HIV
114
Q

Presentation of polyneuritis?

A

Symmetrical and widespread neuropathy, usually begins distally with glove and stocking sensory loss and progressive muscle weakness

Diabetes, B12, wegener’s, HIV, syphilis, alcohol, isoniazid, paraneoplastic

115
Q

What is seen on LP of meningitis caused by:

  • virus?
  • bacteria?
  • TB?
  • aseptic?
A

Virus: high WCC, lymphocytes, normal protein and glucose

Bacteria: Neutrophils, positive Gm stain, high protein, low glucose

TB: lymphocyte predominant WCC, high protein, low glucose

aseptic: all essentially normal, perhaps minimally increased protein

116
Q

What causes progressive multifocal leukoencephalopathy??

A

JC virus

Immunocompromised pts

117
Q

How many attacks of migraine for prophylaxis?

A

2 or more per month

118
Q

Prophylaxis for women with predictable menstrual migraine?

A

Triptan to be taken on those days

119
Q

Triptans:

  • MOA?
  • SE?
  • CI?
A

5-HT1 agonists

SE: ‘triptan effect’ - tingling, heat, heaviness in chest, pressure, tightness of throat

CI: IHD or cerebrovascular disease

120
Q

Prophylaxis of chronic tension headaches?

A

Acupuncture

low dose amitriptyline now widely used but no evidence base

121
Q

Features of cluster headaches?

A

Occur in clusters over a 1-3 month period
Intense, sharp stabbing pain around one eye with lacrimation and conjunctival injection and nasal stuffiness. May have mitosis and ptosis. Lasts 15 mins-2 hours

Acute: 100% oxygen, sc triptan

Prophylaxis: verapamil

122
Q

Features of paroxysmal hemicrania?

A

Similar to cluster headaches, but no cluster of attacks.
Continua version - attacks grow in intensity

Rx: indomethacin

123
Q

Features of TMJ dysfunction?

Management?

A

Cyclical/constant facial pain upon using the jaw, may have abnormal sound when using, tender of masticatory muscles. Often a psych background

NSAIDS
Rest, physio

124
Q

Management of cerebral venous sinus thrombosis?

A

General treatment of raised ICP - head tilt etc

Warfarin +/- heparin
Can be thrombolysed if needed

125
Q

Ix for SAH?
Acute management?
How is hydrocephalus treated?
secondary prevention?

A
  1. CT
  2. LP 12 hours later - xanthochromia
    - > refer to neurosurgery once confirmed

Once confirmed - CT angio for cause

Acute management:

  • induce hypertension with IV saline (maintain perfusion)
  • Nimodipine (21 days, prevents vasospasm)

Hydrocephalus: extra-ventricular drain

Endovascular clipping/coiling

126
Q

Complications of SAH?

A

Rebleed - 50% chance in 6 months

Delayed ischaemia from vasospasm - typically 3-12 days later
-> nimodipine

Hydrocephalus - due to blockage of arachnoid granulations, usually transient, shunt if required

Hyponatraemia - due to SIADH

127
Q

Management of subdural haemorrhage?

A

1st - burr hole craniotomy

2nd - craniotomy

128
Q

Management of epidural haematoma?

A

Clot evacuation and ligation of middle meningeal artery

129
Q

What tumours commonly metastasise to brain?

A 
Lung
Breast
Kidney
Colon
Melanoma
130
Q

Most common primary brain tumour of adults? 4 grades?
Imaging?
Histology?

A

Astrocytoma:
Grade 1 - benign
Grade 2 - largely benign, small malignant potential
Grade 3 - anapaestic astrocytoma (2 year survival)
Grade 4 - glioblastoma multiforme - highly invasive, can develop de novo or from premalignant precursors, survival = 1 year

Imaging: solid tumour with necrotic core and oedema

Histology: pleomorphic cells and necrotic areas

131
Q

2nd commonest primary brain tumour? Histology?

A

Meningioma - arises from dura - round shape

Spindle cells and calcified psammoma bodies

132
Q

Commonest primary brain tumour in kids? Histology?

A

Pilocytic astrocytoma

Histology: rosenthal fibres

133
Q

Medulloblastoma - what is it? histology?

A

Infratentorial brain tumour in kids. Aggressive, spreads through CSF.

Small, blue cells

134
Q

Tumour commonly found in 4th ventricle?

How does it present?

A

Ependymoma

Hydrocephalus

135
Q

What is an oligodendroma?

Histology?

A

Benign, slow growing frontal lobe tumour

Histology: calcifications with fried egg appearance

136
Q

Where do craniopharyngiomas arise?

A

Rathke’s pouch in sellar region

137
Q

1st line imaging for suspected brain tumour?

A

MRI

138
Q

Management of idiopathic intracranial hypertension?

A

Weight loss

Acetazolamide

139
Q

Tabes dorsalis?

A

Neurosyphilis

Loss of DCML modalities only (proprioception and vibration)

140
Q

Anterior cord syndrome?

A

Due to anterior spinal artery occlusion

Bilateral spastic paresis
Bilateral loss of pain and temperature

(due to loss of lateral spinothalamic and lateral corticospinal)

141
Q

Central cord syndrome?
What is affected and why?
Presentation?

A

Usually due to whiplash or in elderly with cervical spinal stenosis

Corticospinal - upper limbs affected (as more central)

Spinothalamic - lost as fibres decussate

Presentation: upper limb weakness and band-like loss of pain, temperature and gross touch

142
Q

Ix for spinal CORD injury with ?

A

CT
MRI for kids

(for trauma - XR first, CT if XR abnormal or if symptoms/signs of spinal cord injury)

143
Q

What tumour is assoc w von Hippel Lindau?

Histology?

A

Haemangioblastoma of cerebellum

Foam cells

144
Q

Who needs to test for brainstem death?

A

2 separate doctors from 2 separate specialties e.g. neurological and anaesthetist

145
Q 
What is pituitary apoplexy?
RF?
Presentation?
Ix?
Management?
A

Sudden enlargement of a pituitary tumour (usually non-functioning macro adenoma) secondary to haemorrhage or infarction

RF: hypertension, pregnancy, trauma, anticoagulation

Pres:

  • sudden onset ‘thunderclap’ headache but felt behind the eye
  • vomiting and neck stiffness
  • bitemporal superior hemianopia
  • extra ocular nerve palsy
  • features of hypopituitarism (hypotension, hyponatraemia etc)

Ix: MRI

Management:

  • urgent steroid replacement due to loss of ACTH
  • careful fluid balance
  • surgery
146
Q

Loss of finger abduction and thumb adduction?

A

T1

147
Q

Head injury:

  • criteria for immediate CT? (6)
  • criteria for CT within 8 hours? (4)
A

Immediate:

  • GCS <13 initially
  • GCS <15 2 hours post-injury
  • suspected skull fracture
  • post-traumatic seizure
  • focal neurological deficit
  • > 1 episode of vomiting

8 hours:

  • age 65+
  • Hx of bleeding/clotting disorders
  • dangerous mechanism of injury
  • > 30 mins retrograde amnesia before event
148
Q

Focal seizure:

  • lip smacking, plucking?
  • posturing?
  • paraesthesia?
  • flashes/floaters?
  • head/leg movements?
  • hallucinations?
  • epigastric rising?
  • post-ictal dysphasia?
A

Lip smacking (automatisms) - temporal lobe

Posturing = frontal lobe

Paraesthsia = parietal lobe

Flashes/floaters = occipital lobe

Head/leg movements = frontal lobe

Hallucinations = tempora; lobe

Epigastric rising = temporal lobe

Post-ictal dysphasia = temporal lobe

149
Q

Hyponatraemia following head injury?

A

SIADH

150
Q

Head injury - diplopia and difficulty opening mouth?

Orbital blowout fracture - what bone?

A

Zygoma fracture

Blow out: maxilla

151
Q

Ix for MS?

A

MRI brain and spine with contrast

152
Q

Food drop, loss of hip abduction, all reflexes intact?

A

L5 radiculopathy

153
Q

Initial steps in haemorrhage stroke/haemorrhagic transformation?

A

Stop/reverse any anti platelet/anticoagulant drugs

Maintain BP to a target 140mmHg systolic

Finals Revision (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions